Provider Demographics
NPI:1982766119
Name:BURSTEIN, ROBERT N (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:BURSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:N
Other - Last Name:BURSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:15 MORGAN FARMS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1372
Mailing Address - Country:US
Mailing Address - Phone:860-644-4741
Mailing Address - Fax:860-644-6805
Practice Address - Street 1:15 MORGAN FARMS DR
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-1372
Practice Address - Country:US
Practice Address - Phone:860-644-4741
Practice Address - Fax:860-644-6805
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4919OtherSTATE LIC #
CT4919OtherSTATE LIC #